Establishing an Integrated Behavioral Health Program
and Practicum Site in a Community-Based Primary Care
Center
Christina S. Lee, Ph.D.
Dept. of Applied Psychology
Northeastern University, Boston, MA
IBH Program Director
2
Integration
Primary Care
• Dan Simpson, M.D.
• Tom Sterne, M.D.
• Deb Clifford, R.N.
Behavioral Health
• Laurie Goldman, Psy.D.,
R.N.
• Ray Walden, L.I.C.S.W.
• Alexander Young, Psy.D.
• Rick Silva, Pharm.D.
• Interns:
– Heather Bennett
– Atsushi Matsumoto
March, 2013 Integrated Behavioral Health (IBH) Program planning begins.
April 20, 2013 Proposal for the IBH Program and Psych Intern training submitted by Dr. Lee to the SECHC. IBH Intern training objective is to pilot IBH training curricula for SECHC psychology interns.
May, 2013 The curriculum for the IBH Program and the IBH Seminar series is developed.
July 1, 2013 Focus group moderated by Dr. Lee with providers (n=15; 4 Adult medicine, 2 Family medicine, 2 Pediatrics, 6 Ob/Gyn, 1 Hass Center) on perceptions of behavioral health before IBH. Suggestions used to improve awareness, training needs, and communication regarding the IBH Program and intern training.
July 15, 2013 IBH Program meeting with interdisciplinary providers and IBH interns
Discussed IBH referral process between provider and consultant, triage process of linking out to care
Sept 6, 2013 First IBH intern class orientation at SECHC.
Sept 10, 2013 Introduction of IBH program to SECHC clinicians. The “Roll-Out” presentation. The purpose of IBH and referral process is presented. Survey and focus group findings presented.
Sept 19, 2013 IBH Seminar Series begins and IBH interns begin shadowing providers
Oct 1, 2013 IBH begins seeing patients
Nov 17, 2013 Breakfast: IBH Program meeting with interdisciplinary providers and IBH interns
Dec 12, 2013 Breakfast: IBH Program meeting with interdisciplinary providers and IBH interns
IBH Planning
IBH intern seminars
Timeline Year 1,
cont.
Jan 25, 2014
Breakfast: IBH Program meeting with
interdisciplinary providers and IBH
interns. Providers give positive feedback
on IBH. Discussion on how to improve
referral system, and advantage of
in-person referral
March 3, 2014 IBH referral process reviewed by Admin
team. Preliminary IBH data reviewed.
New patient screening tools discussed
June 3, 2014
IBH manual drafted
August 4, 2014
Procedures to gather IBH patient
satisfaction survey reviewed. Focus
group with providers planned.
IBH coordination
and Intern
Integrated Health Seminars 2013-2014
1. Functional Assessments and the 5As
2. Integrated behavioral health: Anxiety and depression
3. Medical literacy
4. Writing case notes for integrated care
5. Substance use assessments
6. Crisis management
7. Adult psychopharmacology in mental health, Part I
8. Negotiating behavior change in health behaviors
9. Adult psychopharmacology in mental health Part II
Integrated Behavioral Health Coverage Schedule November 2013
Location: SECHC PAATHS Office 2
ndFlr
IBH Consultant Contact Number: 857-301-0154
Common Reasons for Referral: Stress, Insomnia, Anxiety/Fears, Chronic Pain, Mild Depression, Headache, Anger,
Relationship Problems, Grief or Bereavement, Low Back Pain, Diet (weight loss, dietary adherence problems), Tobacco Use, Exercise, Chronic Illness Management: Diabetes, GI Problems, COPD, Medication Adherence
Services:Consultation (30 minutes) for assessment and behavioral health treatment planning, recommendations, and interventions
Purpose: To help patients develop practical knowledge and skills to promote and improve physical and emotional health
Contact Procedure: Intern provides primary coverage - CONTACT FIRST. Staff provides back-up coverage when necessary
Referral Procedure: Complete IBH Referral Form found in EMR under Letters tab, and (when possible) flag IBH consultant
on call. Introduce patient to IBH consultant and provide IBH consultant with any relevant patient information General Hours of IBH Coverage: 9:00 - 12:00 (AM) and 1:00 – 4:00 (PM)
Monday:
AM
INTERN- Heather Bennett
CONTACT: 857-301-0154
STAFF- Richy Villa
CONTACT: ext. 7671
PM
INTERN- Heather Bennett
CONTACT: 857-301-0154
STAFF- Richy Villa
CONTACT: ext. 7671
*Indicates individual is Spanish speaking
Date: ________________
Patient Name: _________________________ DOB: _________________________
Preferred Language: [ ] English
[ ] Spanish [ ] Other: _______________
Referring Provider: ____________________________
Referral Type:
[ ] Routine [ ] Urgent-seen in 2-3 days
[ ] Emergent
Reason for referral:
[ ] Anxiety
[ ] Grief
[ ] Depression
[ ] Recent Psych Hospitalization
[ ] Smoking Cessation
[ ] ADHD/ADD Evaluation
[ ] Diagnostic Evaluation, e.g. Bipolar, ADD, other
[ ] Substance Abuse
[ ] Other: _____________________________________________________________
Referral to:
[ ] Pharm D: For comprehensive medication management for anxiety, depression, other psychiatric conditions, access to
Specialty BH 3
rdfloor
[ ] CAMI Study: Alcohol use disorders, substance use
[ ] Integrated BH Consultant: For evaluation and short term counseling; e.g. anxiety, depression, relaxation training,
grief, sleep hygiene, smoking cessation, substance use
[ ] Specialty Behavioral Health Service 3
rdfloor
[ ] PLEASE CALL PATIENT: Patient could not see clinician today, but wished to be called
Telephone number (confirmed with patient): ________________________________
NOTE:
IBH will usually see patient up to 3 visits and will refer to Specialty Behavioral Health, 3
rdfloor, if patient needs long term
management.
Importance of in-person referral
Referral
Type
Pts seen
Remaining to be
seen
Total
Paper
52 (36%)
93
145
Verbal
33 (89%)
4
37
Flag
2
1
3
Paper &
Verbal
4
0
4
Total
91
98
189
1. How would you rate the ease of making an initial appointment with the Health and Wellness consultant?
(1) Poor (2) Fair (3) Good (4) Excellent
2. How would you rate the ease of making a follow-up appointment with the Health and Wellness consultant?
(1) Poor (2) Fair (3) Good (4) Excellent
3. Did you get the kind of help you wanted from the Health and Wellness consultant?
(1) No, definitely not (2) No, not really (3) Yes, generally (4) yes definitely
4. How satisfied are you with the help you received from the Health and Wellness consultant?
(1) Quite dissatisfied (2) Indifferent or mildly dissatisfied (3) Mostly satisfied (4) Very satisfied
5. If a friend were in need of similar help, would you recommend the health and wellness consultant to him or her?
(1) No, definitely not (2) No, I don’t think so (3) Yes, I think so (4) Yes, definitely
6. Has the help you received from the Health and Wellness consultant helped you to deal more effectively with your concerns?
(1) No, seemed to make worse (2) No, didn’t really help (3) No, didn’t really help (4) Yes, a great deal
7. In an overall, general sense, how satisfied are you with the help you have received from the Health and Wellness consultant?
(1) Quite dissatisfied (2) Indifferent or mildly dissatisfied (3) Mostly satisfied (4) Very satisfied
8. If you were to seek help again, would you come back to see a health and wellness consultant?
(1) No, definitely not (2) No, I don’t think so (3) Yes, I think so (4) Yes, definitely
